What Is Rectal Cancer Treatment?

Medically Reviewed on 2/1/2023

A senior man receiving a cancer diagnosis
The types of treatment used to treat rectal cancer include surgery, radiation therapy, chemotherapy, active surveillance, targeted therapy, immunotherapy, and immune checkpoint inhibitor therapy.

Rectal cancer can develop when malignant cells proliferate in the rectum. The rectum is a chamber located between the colon and the anus.

What are the stages of rectal cancer?

There are five distinct phases of rectal cancer. Your diagnosis will rely on the size and extent of the rectal tumor:

  • Stage 0: Cancer cells are on the surface of the rectal lining.
  • Stage I: The tumor has proliferated underneath the lining and may have entered the rectal wall.
  • Stage II: The tumor has penetrated the rectal wall and may have spread to the tissues around the rectum.
  • Stage III: The tumor has penetrated several tissues outside the rectal wall, including the lymph nodes close to the rectum.
  • Stage IV: The tumor has metastasized to other distant lymph nodes or organs.

How to treat rectal cancer

The following types of treatment are used to treat rectal cancer:

  • Surgery: The most recommended treatment for rectal cancer at all stages. The malignancy is removed using one of the following surgical procedures:
    • Polypectomy: A polyp (a tiny bulging piece of tissue) is frequently removed during a colonoscopy if malignancy is discovered at the site.
    • Local excision: If the cancer is on the inner surface of the rectum and has not spread into the rectum wall, the malignancy and a small portion of the surrounding healthy tissue is removed.
    • Resection: If the rectum's wall has been affected by cancer, it is removed along with any neighboring healthy tissue. The tissue that lies between the rectum and the abdominal wall may occasionally be removed. The lymph nodes close to the rectum are resected and examined under a microscope for cancerous growth.
    • Radiofrequency ablation: Eliminates cancer cells by utilizing a special probe with tiny electrodes. The probe could be inserted directly through the skin. A topical anesthetic is occasionally needed. Another method is to insert the probe through an abdominal incision. This treatment is conducted in the hospital under general anesthesia.
    • Cryosurgery: Aberrant tissues are frozen and then destroyed using an instrument.
    • Pelvic exenteration: In cases where cancer has metastasized to neighboring organs, the lower colon, rectum, and bladder are removed. In female individuals, the vagina, ovaries, cervix, and nearby lymph nodes could be removed. In male individuals, their prostates could be removed. Stomas (artificial openings) are made to drain urine and feces into a collection bag.
  • Radiation therapy: High-energy radiation, such as X-rays or other forms of radiation, is used to either kill or stop the growth of cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
    • In some cases of rectal cancer, short-course preoperative radiation therapy is employed. Compared to traditional treatment, this method employs fewer and lower radiation doses. Surgery is performed a few days following the last radiation dose.
  • Chemotherapy: Medications inhibit the growth of cancer cells by either killing them or preventing them from proliferating. Chemotherapy is administered differently depending on the stage and location of cancer.
    • Systemic chemotherapy: Administered orally, intravenously, or intramuscularly.
    • Regional chemotherapy: Administered intrathecally to certain regions, such as the cerebrospinal fluid, an organ or a bodily cavity (for example, the abdomen) where the cancer is present.
    • Chemotherapy embolization of the hepatic artery, a type of local chemotherapy, could be used to treat cancer that has spread to the liver.
      • The hepatic portal vein (the main artery supplying blood to the liver) is blocked. The obstruction could be transient or permanent depending on how the artery was blocked.
      • Anticancer drugs are administered between the obstruction and the liver.
      • The arteries are then used to deliver the drugs to a small portion of the body.
  • Active surveillance: Involves close monitoring of a person’s status without administering any treatment unless there are changes in test results. It identifies early indications of disease deterioration. People under active monitoring receive several examinations and tests to determine whether the cancer is spreading. Treatment is used to treat cancer when it starts to spread. The following tests are performed:
  • Targeted therapy: Isolates and destroys cancer cells using medicines or other substances. Compared to chemotherapy and radiation therapy, targeted therapies typically do not kill healthy cells as much. Types of targeted therapies used in the treatment of rectal cancer include
    • Monoclonal antibodies
    • Angiogenesis inhibitors
    • Protein kinase inhibitor therapy
  • Immunotherapy: The body's natural defenses against cancer are boosted, directed, or restored using substances produced by the body or in a lab. This is a form of biological therapy.
  • Immune checkpoint inhibitor therapy: Stops specific immune system cell types, such as T cells and some cancer cells from generating checkpoint-related proteins. These checkpoints keep immune responses from being too strong and occasionally, stop T cells from eliminating cancer cells. T cells can more successfully combat cancer cells when these checkpoints are shut down. They are used to treat some people with metastatic colorectal cancer. There are two types of immune checkpoint inhibitor therapy
    • CTLA-4 inhibitor therapy
    • PD-1 and PD-L1 inhibitor therapy

What is the survival rate for rectal cancer?

Rectal cancer has an overall five-year survival rate of 67 percent. A confined rectal cancer that has not migrated to other parts of the body has a 90 percent five-year survival rate.

Medically Reviewed on 2/1/2023
Improving Treatment Approaches for Rectal Cancer. https://www.nejm.org/doi/full/10.1056/NEJMe2204282

Rectal Cancer Treatment. https://www.hopkinsmedicine.org/health/conditions-and-diseases/colon-cancer/rectal-cancer-treatment

Rectal Cancer. https://my.clevelandclinic.org/health/diseases/21733-rectal-cancer

Rectal Cancer. https://www.mayoclinic.org/diseases-conditions/rectal-cancer/diagnosis-treatment/drc-20352889

Rectal Cancer Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq#_111

Survival Rates for Colorectal Cancer. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html